Many articles about diabetes appear daily, many of them very interesting. The intent here is to make some of these available for others who may not see them or have bypassed them. I will try to comment briefly on those I have grouped or on an individual article. This is not guaranteed to be a daily post, but I hope that this will give you ideas for your own research or blog posts. Please talk to your doctor about medical problems.

16 August 2011

Sorry folks, but posting to two blogs is more than I can handle now. So for the future, I will leave this blog in place, but I doubt that I will add to it. I am even cutting this blog to five days per week and some weeks it may be less, but the intention is to do five blogs there per week.

Thank you for reading this blog and I hope that you will continue with me on the one mentioned above.

10 August 2011

Rather than reprinting the newsletter, I will direct you to it and let your read it. Living Cell Technologies is fast out pacing the rest of the world in cell therapies for diabetes and may soon have products in Japan, China, and other countries.

The biggest plus is the lack of need for the use of any immunosuppression. As a person with type 2 diabetes, this is still very exciting news and especially for those that are type 1 and hypoglycemically unaware.

09 August 2011

When I wrote my original blog of suggestions for World Diabetes Day, I never imagined the feedback I would receive. I expected some objections to my wanting to cancel some building lighting, but this did not seem to bother most people.

To date, I have received one tentative support email that said the USA was not ready for this yet. Two people seemed very much identical in their thoughts about where I should put my suggestions – in a place where the sun doesn't shine. Two other emails had other ideas and that we should worry about our own people in need of diabetes supplies before helping people outside this country.

The sixth email bothers me the most. It used language that is not printable and some that I have not heard since the days before Martin Luther King. This talk reminded me of a few types of individuals dishonorably discharged from the military for their racial hatred and white supremacy views. I did not like it then, and I don't like it now.

So for putting the suggestions out in a blog, I had not expected this type of opposition and feelings, but so be it. That we have this type of people in the USA is not a surprise and even that they are so selfish and self-centered. That they would email me is also not a surprise as I asked for them, and I am very sure they used temporary email addresses to avoid return emails as those I have sent did not go and returned error messages.

Six emails and no comments until August 8, tells me what people think and feel about IDF and helping them. A sad feeling for me. I can only do so much as one individual, but I will do it just the same. I am more encouraged now after a few comments from others in the DOC.

Since writing this I have had two other emails, while not totally positive, were somewhat encouraging, but doubted that with the current economy there would be much support for organizations like the IDF or even ADA after receiving the email from the ADA expressing so much fear for what was going to happen to those receiving Medicare and Medicaid. Read my blog here.

08 August 2011

First a definition of hyponatremia – a deficiency of sodium in the blood or abnormally low concentration of sodium ions in blood. Lisinopril is an angiotensin converting enzyme (ACE) inhibiting drug administered as an antihypertensive and after heart attacks. This is used by many people for combating high blood pressure and often in combination with other drugs.

Hyponatremia is listed on the drug label insert as a potential adverse event but does not occur that frequently. The signs and symptoms of hyponatremia include nausea, malaise, headache, lethargy, seizures, coma, respiratory depression and decreased sodium levels.

Often the cause of hyponatremia was purported to be the result of a drug-induced syndrome of inappropriate secretion of anti-diuretic hormone (SIADH). When suppression of anti-diuretic hormone is impaired, which may be induced by ACE inhibitors, water is retained and sodium is lost. None of my test results have given any indication of this happening for me.

Although case reports suggest that ACE inhibitor therapy may cause hyponatremia (even at low doses), do not forget that other agents or medical conditions that may carry added risks for hyponatremia. For example, the risk for hyponatremia may be greater in patients also on diuretic therapy or who have congestive heart failure. There are limitations in drawing conclusions from case reports, it remains prudent to monitor electrolyte levels in patients on ACE inhibitor therapy, namely serum sodium and serum potassium. Hyponatremia is recognized as a potential adverse effect of ACE inhibitor therapy, with grave consequences if left uncorrected. Both patients and physicians should be aware of the signs and symptoms of hyponatremia.

05 August 2011

This case is going to set some new standards and it is too early to know which way the standards will settle. Two law professors are arguing for healthcare organizations to be spared from having to "prepare endlessly for every contingency." While I can agree with part of this, I do feel that healthcare organizations should not be exempt from negligence and carelessness.

There are a lot of unanswered questions about what actually happened to patients at Memorial Medical Center in New Orleans and we will probably never know the full truth. Some potential charges were dropped and will be buried in the archives of the legal system.

The other question on my mind is if healthcare organizations are even interested in being prepared for emergencies. Most have the emergency preparedness papers in a file for satisfaction of various inspection agencies, but do all the employees even know the basic steps and even the backup plans? Highly doubtful! How often do they have a drill for preparedness? Most will do this during the daytime maybe once a year to minimize the cost, but those on the evening and night shifts may have been told that there is one, but don't know anything about the procedures and plan of action.

Most healthcare organizations have only one or two types of emergencies to be concerned about from the weather. Most are build out of the flood plains so what happened during hurricane Katrina is a rare occurrence except in the hurricane prone areas. The rest need to worry about tornadoes and winter storms from the weather. They all must be concerned about fires and terrorism.

So the question becomes, should they be allowed a blanket exemption from lawsuits, or will lawsuits still be allowed for negligence? I would not be happy with a blanket exemption. If this even comes close to reality, I would urge everyone to require that healthcare organizations be required to undergo state monitored, unannounced emergency preparedness drills at least twice a year and preferably on a quarterly basis. This would insure new employees are prepared and that they happen.

This would also require that state agencies be prepared to conduct the drills at varying times and not just for one shift. Most state inspections that exist now happen between the hours of 8:00 AM and 5:00 PM. This often leaves the night shift exempt and without training for any type of emergency.

Read the article here and then decide what you think, be prepared to take a stand or bury your head in the sand. Emergencies happen and if you happen to be in a healthcare facility during an emergency, what would you want?

04 August 2011

This is somewhat like rules to protect the rule breakers. Yes, a little extreme, but when it comes to the government writing rules, this includes everyone but those in the government. The largest abuser of human subjects is the Veterans Administration which seemingly gets to do what it wants to abuse veterans in trails and studies. But this is just my view of existing rules and the new rules being proposed.

The article in the New England Journal of Medicine (NEJM) lays out the history of the current rules first. Then it discusses the process of revising the current rules and the place to view the proposed new rules. While the responsibility of enforcing the rules rests with about 14 different federal departments and the Food and Drug Administration has similar but not identical regulations.

Most of the identification and investigation still rests with institutional review boards (IRBs), but as directed by the different federal departments for oversight. These IRBs need to be freed of some burdens to be able to their duties more effectively.

Two important items for discussion and potential revision of the rules (very much needed) is the exempt category and enhancing protections for research participants. Many studies continue to have the risk of having private information and inappropriate information released to the public. The proposal of having these studies in the exempt category fall under the rules of the Health Insurance Portability and Accountability Act (HIPAA) is one of the better proposed rule changes.

The enhancing protections for research participants topic has many good suggestions and all need consideration. Briefly they are closing the gap that some studies use to bypass federal oversight, consolidation of reporting requirements of adverse events, revising informed consent documents to eliminate lengthy legal boilerplating, and making them more readable for knowledgeable informed consent, and finally rules about biospecimens – their control and use.

The one area I have not found any concern about are for regarding human participants is the Veterans Administration. Since they are a government entity, they do not seem the have an IRB to review their activities or any agency to discipline them for their rule violations. Therefore this is an area that needs attention and the Secretary of Defense needs to be able to empower a board of review for the Veterans Administration's abuse of our veterans. Yes, the Department of Defense (DOD) and the Department of Veterans Affairs (DVA) have some reporting requirements for adverse events, but there seems to be no oversight or requirements for failure to report.

The authors do state that some reforms are needed now with the growing body of human participants and new types of research. They appropriately warn that these reforms should not be delayed for another 20 years.

03 August 2011

Although this study is little different from the other European studies published recently it does add a few insights and hypothesize on some other ideas and for that I will give them credit. However, they leave a few things unstated that need definition. When they use the term conventional, they do nothing to enlighten readers about how the term is being used or meant to indicate.

From some other statements, we are left wondering what they consider normal blood glucose levels. We can all guess when they say normal levels of people without diabetes. So normal levels for people with diabetes is considered ??? (guessing about 7.0 on the US A1c scale).

One thing everyone seems very concerned about in all the articles published recently is hypoglycemia. I do agree that it is something to be concerned about, but unless you are hypoglycemically unaware or afraid to test, I find this argument less than appealing in proper management of diabetes. It is always a factor that needs careful attention and concern, but if a person is careful and understands their body, a blood glucose level of 5.5 to 6.4 A1c is attainable without intensive lowering therapy.

Then when you add exercise and nutritional restraint it is even more attainable and the blood glucose level of 5.0 is reasonable. I will admit that I would be concerned about getting to the level of 4.5 for an A1c and the possibility of hypoglycemia.

The authors state that while there was little difference between intensive and conventional blood glucose therapy, there is a definite advantage for lower blood glucose levels in reducing the small blood vessel damage leading to damage to the eyes and kidneys. They forget to mention the additional advantages of lower blood glucose levels in preventing blood vessel damage to the inner ear to prevent hearing loss and the prevention of diabetic neuropathy.

This study basically covers the same ground as the German and French studies, but it was done in Denmark. I have written about these studies also. The press release for this study can be read here.

02 August 2011

You Think!!!. Hopefully results from a new study will end the plate method of nutrition. The study shows that adults who consume 25 percent of their daily calories from fructose or high-fructose corn syrup beverages for two weeks experience increases in serum levels of cholesterol and triglycerides. Yet, this percentage is within the current government guidelines. Another reason why we don't need government involvement in nutritional guidelines.

The authors of the latest study are hoping the results will spur the government to reevaluate the guidelines. Fat chance, I say for this to happen as this would have to affect government subsidies and turn certain agricultural interests against government.
While the official print is not set for publication until October 2011, the press release is interesting and thought provoking to say it mildly.

Senior author Kimber Stanhope, PhD, from the departments of nutrition and molecular biosciences, University of California, Davis, and colleagues say “the study was conducted to help sort out a discrepancy in 2 prominent sets of recommendations - the Dietary Guidelines for Americans, jointly published by the US Department of Health and Human Services and the US Department of Agriculture, recommend that people consume a maximum of 25% of their daily calories as added sugars. In contrast, the American Heart Association recommends an upper limit of 5%.”

"While there is evidence that people who consume sugar are more likely to have heart disease or diabetes, it is controversial as to whether high sugar diets may actually promote these diseases, and dietary guidelines are conflicting," remarked Dr. Stanhope in a press release.

The study was done to highlight the effects of the higher government-recommended limits of sugar consumption. The study is too small (48 individuals) to be taken seriously and involved consuming beverages that contained fructose, high-fructose corn syrup, or glucose at the 25 percent upper limit for calorie intake for two weeks. The study did not include sucrose.

The researchers claim that survey (but no data from any survey is included) suggests that thirteen percent of the US population consumes 25 percent or more of their calories from added sugar. The researchers conclude, their findings indicate the need for the government to reconsider its recommendations that the maximum upper limit of 25 percent of total energy be received from added sugar.

For this study to be sufficient to make such bold recommendations seems a stretch and more like a plea (although not part of the release) for funding of a larger study.

01 August 2011

This sounds exciting and for once the medical students are the guinea pigs. Will this mean more compassionate doctors? This will remain to be seen, but I like the analogies used in the article. What is discouraging is the length of time required to make this a national program and not just at two medical schools working together.

Stephen Klasko, MD, MBA, dean of the University of South Florida (USF) College of Medicine in Tampa, where the SELECT (Scholarly Excellence. Leadership Experiences. Collaborative Training) program is based stated, “we intend to change the DNA of healthcare, one future physician leader at a time. This medical school admissions program is set up to consider the individual's emotional intelligence in addition to the individual's ability to memorize organic chemistry formulas and score high on MCAT.

Dr Klasko said that he has observed medical care shifting from the model of the kindly Dr. Welby to the narcissistic, brusk, but brilliant Dr. House. The SELECT program is meant to produce physicians who will be as bright as Dr. House, but as compassionate as Dr. Welby.

SELECT was jointly created and operated by USF College of Medicine, where students will spend their first 2 years, and Lehigh Valley Health Network (LVHN) in Allentown, Pennsylvania, where they will complete their clinical training within a healthcare network that shares this philosophy.

The four-year program will have new methods to teach the science and technical expertise that are needed for the practice of medicine while putting patients and their needs and expectations at the forefront.

I will let you read about the details in the article here. I find this promising for the future of medicine where doctors will not use fear and myths to frighten patients, but use their intelligence to enlighten patients and teach patients what needs to be accomplished for their better health. This will put the patient first and the medical problem as part of the patients desires and goals.

29 July 2011

When are researchers and doctors going to wake up and learn? Apparently never! Another study published in the British Medical Journal (BMJ) warns doctors about placing their Type 2 diabetes patients on intensive glucose lowering treatments. Again they say that most doctors do this believing the patient will have a reduced risk of heart complications.

This time the study was done in France. They did not name this study shamefully so that we had something to refer to like we did in previous studies. Plus no mention was given as to whether this meta study used much of the same data used in other studies - ACCORD and ADVANCE or even the study done by the German group IQWiG, the Foundation for Quality and Efficiency in Health Care. For all we know they could have used the same information.

Again the researchers arrive at the same conclusion that there was no compelling reason to use intensive glucose-lowering treatment, also known as glycemic lowering therapies as are commonly prescribed in order to reduce the diabetes type 2 patient's risk of having cardiovascular complications, as well as renal and/or visual problems.

The researchers found the following benefits were identified with intensive glucose lowering treatments - the risk of non-fatal heart attacks dropped by 15% and the risk of microalbuminuria fell by 10% (an indication of heart disease and kidney problems). However, the treatment was associated with a 100% increase in the risk of dangerously low blood glucose levels (severe hypoglycemia).

The the authors felt it necessary to say - "Intensive glucose lowering treatment of type 2 diabetes should be considered with caution and therapeutic escalation should be limited."

It is not surprising that researchers and doctors repeatedly analyze data looking for information that is not there. Like others have said, bad results are obtained when the incorrect premise is used. In other words, bad science because they were looking for the wrong answers. Like Alan said in his blog (here) and I repeated in my previous blog (here), no consideration was done for changing lifestyle habits of diet and exercise.

If people will not change their lifestyles and are put on intensive glucose-lowering therapies, there is no reason to expect anything other than the results obtained. I say that they should stop spending money on worthless analysis of things that we already know, and concentrate on ways to get the results needed to reduce cardiovascular events and the other complications diabetes can cause. This means looking at what lifestyle changes will accomplish this and how best to work with patients to obtain these results.

This needs to be a lengthy study as it does take time for people to get into an exercise routine that they can sustain and enjoy. Changes in eating habits also take time as people have developed bad habits over time and will have to be shown how to sustain good eating habits and get past the hunger pangs and into good dietary habits. Other lifestyle changes will also be necessary such as regular eating times and carbohydrate counting will become necessary.

Then once these are in full operation and patients are seeing results, then glucose-lowering therapies can be gradually introduced if needed to assist patients in achieving their goals and possible reduce or prevent the related diabetes complications. It should be possible to patients to do lifestyle changes to manage diabetes and lower the risks for complications – if done properly.

28 July 2011

Everyone seems concerned with Type 2 diabetes and the advantages and disadvantages of maintaining near or normal blood glucose levels. What no one is willing to tell us is a way to maintain stable blood glucose levels.

The advantages of maintaining lower blood glucose levels are less risk of heart attacks, kidney failure, neuropathy, and loss of eyesight. The disadvantage generally is listed as one problem and that is hypoglycemia. Generally hypoglycemia is listed as blood glucose readings below 70 mg/dl. I would agree that this should be the lower limit for most people and for some nearer to 80 mg/dl. I admit that I do not get concerned until I get lower than 65 mg/dl, but this is not good for most people.

I will not discuss the study from Germany that has so many flaws in it that it is easy to understand why they take the position they do. When a healthcare system is operated by the government, cost is always at issue and often best results are deemphasized at the harm of the patient. Alan at loraldiabetes does an excellent job of analyzing the study and showing its weaknesses and I urge you to read his blog about this.

I do need to quote Alan here though – Quote The problem (of the study) is not the goals but the methods. Sadly, all they have done is confirm something that has been discussed by type 2 diabetics on diabetes forums ever since ACCORD and ADVANCE (both are included in this meta-study) were published. Those papers did not show that tight control is harmful, instead they showed that intensive use of oral medications and/or insulin to push A1c or FBG down can be hazardous to the health of a diabetic.

The factor missing from all of these studies is use of lifestyle changes, particularly diet and exercise, to achieve near-normal A1c and blood glucose levels. Repeatedly in all these studies the subjects were advised to follow the traditional (since Keyes) extremely low-fat high-carbohydrate diet and to then use medications and insulin to combat the results of that way of eating. I wrote some brief comments on the ACCORD and ADVANCE trials back in 2008 when they came out; nothing has changed since then. Unquote.

This is so typical of studies and points out why we should not rely on them for our own care. They do not consider the essential lifestyle changes that need to be made in diet and exercise. Until researchers understand the value of people and what is reasonable, studies like this will proliferate and doctors will continue to discourage people from attempting to manage diabetes to their abilities and benefit. Doctors will use studies like Alan covers to instill fear by citing them.

So now, not only is it necessary for us a patients to be more proactive in our care, but we need to be aware of these studies and how to refute them when they are used by doctors to discourage testing and bringing our A1c's closer to the normal range.

27 July 2011

Dignity therapy, this is a topic that does need more publicity. Especially for those in nursing homes, hospice care, and hospitals. Having visited with people that have parents or relatives in a nursing home, it seems that this is one place that very sorely needs some guidance in providing “dignity therapy”. For nursing homes and hospice care, dignity therapy may need to be adapted to fit the needs of the people.

So places the provide care for the elderly need to learn how to use dignity therapy and allow time for the elderly to be properly cared for. It is not just a nursing home or care facility here and there, but on a nationwide basis, the level of care and treating the elderly with dignity sometimes is very lax. I would even say that some of those housed in nursing homes are often stripped of their dignity more than they are helped in maintaining even a small semblance of dignity. While many of the nursing homes are working to be better and meet state mandates, it takes time to weed out undesirable employees.

What makes the application of dignity therapy so difficult in most settings is that many people are housed in nursing homes and care facilities and are put there because they no longer are capable of caring for themselves. The fact that the majority cannot verbalize their feelings any longer makes it difficult to know whether they are happy or even being allow to keep any dignity.

This needs to change and those working in nursing homes need formal training on caring for people in nursing homes to allow them as much dignity as can be managed.
Yes, this can be difficult. Some people are not easy to deal with and many have been dumped in a nursing home (yes, I said dumped) because the family can no longer deal with them. Others have signed a medical power of attorney for a family member that does not exercise good management and listens to other family members wanting access to whatever assets the parent has.

Sometimes there are few family members available to spread the care-giving around and the one person has no choice for their health, but to put a parent in a nursing home. The care has become too much of a health burden for them to continue without damaging their own health.

Therefore, dignity therapy needs to be taught not only to nursing homes in a modified format, but to family caregivers as well. If done early on and properly, this can easy the transition when a nursing home is no longer unavoidable. Often there are alternatives which can assist family caregivers and allow a single family caregiver the break that they need for managing their own health.

Dignity therapy can have many forms and be a useful tool in not only caring for the terminally ill, but for the elderly that find they cannot care for themselves any longer.

26 July 2011

Dignity therapy involves a short course in psychotherapy that focuses on helping patients with life-threatening or life-limiting illnesses, that are capable of verbalizing themselves, to do so in a manner that allows them to feel that they can accomplish needed activities in the end-of-life setting.

It encourages these patients to heal family relationships and express themselves in what they desire for the following generations plus pass along information to the younger generations. This form of therapy also encourages saying things to loved ones that have remained unsaid to achieve closure. The therapist then helps the patient craft a meaningful document based on the 60-minute sessions.

By using dignity therapy for those that had less than six months to live, it helped them find some meaning and purpose to the end of life and to share their life's story and experiences with family members. When you talk to people about their life, you allow them to step out of the current situation and become the parent, business person or what their occupation was. This allows the patient to be someone and not just a number.

Getting to know the person, not the patient, allows them the opportunity to explain what their role has been in the family, the community, and express what they are happy about in what they have accomplished. The researchers comment that the patients who received dignity therapy “often has a quality-of-life experience that they could not have expected and although this is difficult to assess, it can be poignant and profound.

As an example, it is stated that a 56-year-old woman said: “Mostly, I want my family to know that I'm okay with dying and they must move on. The therapy showed me that I am not the cancer, I am still in here. I am so grateful for that because I lost myself.... It really helped me remember who I am.”

Several authorities who reviewed the study commented that this type of therapy should be offered to all patients with terminal illnesses. The feeling has been that if you don;t have a long time to be in therapy, it won't be helpful, but that is not true. Dignity therapy will help patients finish their lives on a positive note and can go far in healing familial relations that might be undone otherwise.

The transition from active treatment to palliative care is often difficult for patients and their families, and this can even be true for healthcare professionals intimately involved with the care of the patient. Psychotherapeutic interventions, such as dignity therapy, offer timely opportunities for patients and families to address important issues.

This stood out as an important issue in the study report. There are some other thoughts that are helpful in the results of the study that you can read here and another report here.

25 July 2011

This is not surprising, and even with this study being done in the country of Canada, the truth of the study is applicable in the USA. I think this is a good thing and every person with diabetes would be better off if they could eliminate this profession. Replace this with people specializing in diabetes that can educate, give sound nutritional advice and not spout dogma from the professional associations. Most people have to find this out on their own and suffer because of the carbohydrate advice spouted by certified diabetes educators (CDEs).

I have started this blog several times and always end up erasing it. So I might as well vent my feelings. Yes, there are some excellent CDEs, but they are few and far between and in positions where they do not need to worry about losing their license for not spouting the dogma that is outdated. If you have one of these that is concerned about your health and your desires for lifestyle changes to lower carbohydrates, do everything possible to stay with this person.

If you are fortunate enough to have a dietitian specializing in diabetes that is more concerned about the nutrition of the food you are eating and not the number of carbohydrates, work with this person and you will benefit in your diabetes management. I have needed to go outside of my doctor's office to find these people and I am happy I did.

I will let you read the article and the abstract on diabetes educators and the problems in Canada, but I think you will agree that these same problems exist in the USA and maybe on a larger scale. The good diabetes educators are in high demand and can be found with some diligent searching. The largest problem is finding them in largely rural areas.

Many of those not utilized by doctors are the ones that contradict the doctor and do other things that are not in the best interest of the patient. Doctors soon realize this and refuse to refer patients. And patients that are proactive in their care will tell their doctors about poor CDEs.

CDEs can be very useful in educating patients about diabetes and using the equipment, taking medications, and providing support – if they would leave nutrition for the nutritionists or dietitians specializing in diabetes.

22 July 2011

Not able to afford dental care? Are there no dental clinics near where you live? If so, your are like about 33 million other Americans. In a report from the Institute of Medicine (IOM) and the National Research Council (NRC) they stated that the 33 million Americans live in areas with too few dentists to meet their needs, and millions of children and retirees lack access to good oral health care because they cannot afford it.

Under current economic conditions, it is doubtful that the recommendations of the report will have much success. Still you need to know what the report said:

According to the report:

33.3 million people reside in areas where there aren't enough dental health professionals to meet the population's needs;

In 2008, 4.6 million children went without needed dental care because their families lacked the financial means to pay for it;

In 2006, almost two-thirds (62%) of U.S. retirees did not have dental health care coverage (Medicare does not cover dental health).

To read the full report (242 pages) go to this link. A free downloadable PDF file is available in a box in the left column. Click on the download button and you will need to complete and form and then you will be able to download the file to your computer.
I have completed the first 100 pages, but the first approximately 30 pages covers most information and then the detail starts.

The experts stated that, “deteriorating dental health can have broader consequences for overall well-being. For example, poor oral health has been linked to heightened odds for respiratory illness, heart disease and diabetes. Rates of inappropriate use of emergency services also rise for those with poorer dental health.”

This is important to read and understand what may happen and if something appears in the news you will have some understand about what it may mean. Good luck and good dental health.

21 July 2011

I was not even aware of this happening until I received an email about the awards. Apparently if you live east of the Mississippi River, there are places that want you to be healthy. St. Paul is the western most place give an award. Rather than duplicate this, I will let you read the press release here.

If you live in or near the award winners, check them out and see what they are doing for the health of the areas. As HHS Secretary Sebelius Kathleen states, “The 2011 Healthy Living Innovation Awards represented an exciting chance to foster the spread of effective, community-based efforts that employ innovative approaches to promote healthy weight, physical activity and nutrition,” said Secretary Sebelius. “Communities across the United States submitted creative, replicable and sustainable innovations that demonstrate outstanding leadership and promising results.”

20 July 2011

It is about time! I just hope that the snoopers got enough money from passing on private medical information about the involved celebrities – they are going to need it for their defense. At lease the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) handed down a penalty of sizable value and ordered the University of California at Los Angeles Health System (UCLAHS) to submit a corrective action plan to close the holes in its compliance with the rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules.

This reflects the policies and procedures required by HIPAA and lets hospitals and medical offices know that the HHS is serious about enforcing the rules. Covered entities must reasonably guard medical records from prying eyes. Employees that chose to disregard these rules must be sanctioned, i.e. either authorized under strict rules, or penalized for violations. All employees must be aware of the rules and trained about the confidential nature of private medical records.

UCLAHS is responsible for the actions of its employees and must now train said employees in meaningful policies and procedures, including audit trails to insure access is by authorized personnel only. There must also be a clear plan in place to deal with employees that choose to violate the rules. Casual viewing of patient health information is unacceptable and against the law and employees can be prosecuted. OCR will continue to vigorously enforce the protections.

This is also an important reason to check your records once the new addition allowing patients of obtain a list of people viewing their records and for what purpose. I blogged about this a short time ago and you may read about it here. The press release about the UCLAHS violation can be read here.

19 July 2011

Hope Warshaw says in her June 12, 2011 blog “As a DHCP I’ve long realized I can’t walk a mile in a PWD shoes. I can’t know what it is like day in, day out to deal with this challenging and relentless disease.” DHCP stands for diabetes educator/healthcare provider. She wisely left out educator in the acronym because she has raised the ire of many bloggers and Type 2 people with diabetes in her latest pronouncement on Diabetes Health on June 28, 2011.

So it is obvious that Mz Warshaw is not a person with diabetes. But her article did stir up feelings about low carb when she advocated high carb. What it may have done is get something out in the open to be debated by people in the know about the benefits of low carb and let the general populace know what is needed to put a stop to the obesity epidemic in our country.

In the first part of her two part article, Hope Warshaw also missed the mark by not emphasizing that prediabetes can be managed with diet and exercise if detected early enough and people are educated about this and taught to work on weight reduction and not eating high carb as she directs in part two. She seems to advocate a one size fits all approach which for Type 2 diabetes just does not work.

I will not carry this farther, but will let you read some of the articles this has spawned and the anger in some of the comments. The best and most objective blog is by Laura Dolson of about dot com. The two Hope Warshaw articles are here and here. Another excellent blog about what may be happening is here.

18 July 2011

Hit them in the pocket book seems to be the only way the get the attention of Hospitals. This is exactly what the Centers for Medicare and Medicaid Services (CMS) has done and it is having widespread impact. While this needs to be expanded and incentives put in place, it is proving to have an effect and may lead to more actions.

Although I take my shots at the CMS for its euthanasia policies, for once I have to praise them to being on the right path. Those in the medical professions working in hospitals have ignored medically caused infections as just the cost of doing business, when if fact, this is caused by sloppy procedures and carelessness on the part of the people themselves.

Now we need to be concerned about hospital coding procedures and the fraudulent practices of some hospitals. While they say that they are working for coding accuracy, I think this is hospital talk for coding to hide the actual happenings. The survey has one gigantic fault – it did not look at whether the CMS policy actually caused a reduction in infections. The CMS no-payment policy appears to have had a positive impact on hospital infection prevention and control efforts though.

But first, lets use some of the terms for clarity. Infection preventionists is for a medical professional specializing in preventing infections in the hospital settings. This is a recent addition for many hospitals. The next is hospital-acquired conditions (HAC) and this includes much of what is targeted by CMS policy. Healthcare-associated infections (HAI) at present is not targeted by CMS. Catheter-associated urinary tract infections (CAUTIs) is a large concern and catheter-associated bloodstream infections (CLABSIs) bothers me as well.

The Association for Professionals in Infection Control and Epidemiology (APIC) is the professional organization which was conceived in 1972 in recognition of the need for an organized, systematic approach to the "control" of infections acquired as a result of hospitalization. Originally called The Association for Practitioners in Infection Control, the name was changed to the Association for Professionals in Infection Control and Epidemiology, Inc. in 1994 to recognize the organization's maturation and evolution into the broader context of health care delivery in this country. This includes the study of non-infectious adverse outcomes and the movement of care outside the traditional health care system, specifically the hospital. They have even expanded to include activities in Bioterrorism.

In the first paragraph, I mentioned putting incentives in place. This could mean that the hospitals that actually (and not by coding) reduce HACs could receive a bonus for a reduction. I'll leave this to the experts to determine a formula, but this could also help. Would I assess a penalty for an increase in HACs – by all means, even up to losing all CMS monies. Patient safety needs to be a number one priority.

Of course the food industry is not going to give in to the Obama administration. They are going to test the water and hold out for not reducing much of anything in the name of taste and getting the public to eat their food. It would be economic suicide to to otherwise. According to the food industry, the public just would not eat the food if it had to follow the suggested guidelines of the Obama administration.

Of course, they have not gone far, as they are only setting the standards for foods that can be advertised to children. In this category, they are reducing sugar, salt, calories, and fat. And this is only the nation's largest food makers. It does not include the rest of the food manufacturers. Whether all will follow these standards remains to be seen. If a food falls in sales, I would guess it will return to what it was.

In April, the U.S. government issued guidelines it said it hopes the food industry will adopt for lower amounts of sugar, salt and fats in foods advertised to children. Those guidelines are lower than the new industry guidelines just issued. The spokeswoman for the food industry called the guidelines “unrealistic and unattainable” and said “the government should modify its guidelines”.

She stated, "We share the same goals as these government agencies. We all want healthier kids," she said. "But we think the government's proposal is unworkable and unrealistic."

It is unfortunate that the food industry has taken this stance as the Obama administration will now probably step in and we will have government in the food industry more that it already is.

Obesity expert Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, said "No one with a modicum of real-world common sense is surprised that the home-grown standards of food companies are less restrictive than the government standards the same companies rejected."

"The right approach, which the industry does not even seem to be considering, would be to link marketing to a reliable measure of overall nutritional quality, not just a select nutrient or two. One-nutrient-at-a-time guidance can be entirely misleading," Katz added.

When we are told that an estimated one-third of U.S. children are now considered overweight or obese, the food industry has an obligation which they are abdicating in favor of profits. Children that weigh too much are at risk for high blood pressure, high cholesterol, type 2 diabetes, breathing problems, such as sleep apnea, and asthma, joint problems, and fatty liver disease. Then to these you may add discrimination, and poor self-esteem, which can continue into adult life.

So the food industries have said no to doing anything meaningful to help the problem for our children. Read the press release here.

15 July 2011

Well, it seems that the Federal Drug Administration is willing to admit when it has short comings. But it is going to regulate the latest entry – nanotechnology. Noting the “critical need to learn more” about the impact of nanotechnology on medicines and medical devices, the FDA has asked for help.

Speaking out in support of this action by FDA, is Gang Bao, director of the Center for Pediatric Nanomedicine, a joint project of the Georgia Institute of Technology, Emory University, and Children's Healthcare of Atlanta.

Jamey Marth, PhD, director of the Sanford Burnham Center for Nanomedicine at the University of California, Santa Barbara said that the application of this technology is truly revolutionary.

In nanomedicine it is difficult, but important, to understand the scale of the nano. A nanometer (nm) is a billionth of a meter. For example a single sugar molecule in 1 nm in diameter, the DNA helix is 2 nm in diameter, a typical virus in 75 nm in size and a red blood cell is 7000 nm.

According to Jamey Marth, we have not been able to answer all question about a lot of diseases. These diseases, diabetes, cardiovascular disease, disease of aging, and cancer have some genetic bearing, but this is only part of the answer. With nanomedicine we will be able to identify and discover those processes that are outside our genetic makeup. Nanomedicine give us new tools to treat disease.

The FDA has already approved two cancer drugs based on nanotechnology. Besides better treatment with few side effects, the second generation drugs of this type will carry nanoparticles on their surfaces that not only target the drugs to cancer cells, but also allow them to penetrate deep into tumors.

Marth says that nanomedicine will speed the discovery of biomarkers that identify diseased cells. Once these biomarkers are found, they can be used to bind therapeutic nanoparticles only to the cells that need them, leaving normal cells alone. Bao's team is pioneering another approach: using nanoparticles to repair genetic mutations. Their first target will be the mutation that causes sickle cell disease.

The major task ahead for the FDA will be to set guidelines for demonstrating that new nanomedicines are safe. But Marth says there are both toxic and nontoxic approaches to nanomedicine. Even so, Bao says the FDA guidance will be important, as materials that behave one way on a normal scale can behave quite differently at a nanoscale.

"There might be some unique features of nanoparticles that induce some toxic effects," Bao suggests. "If they could get into the body, stay in the cells, not be cleared, there might be some harmful effects down the road, and we need to understand that. We do not think the particles we use have any intrinsic toxicity, but we need to know this for sure."

12 July 2011

Are you a person that takes your blood pressure at home? If so is it consistently lower than that taken in the doctor's office? If so, you may have “white coat effect” (or syndrome if your prefer) or an alternate problem that you have not been allowed to rest for the five minutes before they take your blood pressure. In some offices and clinics, there is a lengthy walk before arriving at the office where the doctor will see you.

This walk can be just enough to start to raise your blood pressure, and then some nurses insist that they take your BP just as soon as you sit down. So just remember that both can affect you blood pressure and the combination can add to the measurement in the doctor's office. Of course, there is a third alternative for men – the nurse may be very attractive – sorry, we won't go there.

Researchers at Duke University and the Durham, NC VA Medical Center have completed a study that supports the white coat syndrome. The study reports that blood pressure readings were consistently higher in the doctors' offices than those taken at home or even in the research setting. While doctors generally rely on one or two BP readings to determine if the patients need treatment for high blood pressure or if it is controlled sufficiently by patients already on medications. This study points out that changes need to be considered.

The researchers felt that repeated measurements taken at home may help give a more accurate display of blood pressure management that a single reading in a doctor's office. The research findings support the idea that the stress of a medical exam can cause large elevations in blood pressure. The researchers also stated that blood pressure normally fluctuates from hour to hour and from day to day, but even knowing this, they were surprised by the large differences between clinic and home readings.

The message for patients is that it is extremely difficult for doctors to know if BP is in or out of control without having multiple measurements. Because of the large differences between clinic and home readings, it is important to take home readings with you to the doctor as this can help the doctor make better decisions for you. Also be aware the some doctors do not accept home BP readings and will ignore them – possibly to your detriment. So discussion beforehand may be necessary.

11 July 2011

I might have known that the old guard medical establishment would not give up easily. When I wrote this blog in January, I accused the old guard of using medical hazing like they were initiating college freshmen. Old habit dies hard, and the old guard has had to give way on first year residents, but after that it appears all bets are off until the next legal battle. In the interim, the initiations must go forward.

Never mind the errors medical residents will make and patients that may have their lives taken or damaged, medical initiation for medical residents must continue. Flying in the face of patient safety and reasonable work hours, effective July 1, 2011, medical residents can be scheduled to work up to 24 hours straight through and then have an additional 4 hours tacked on to their working schedule.

As patients, we can only hope that the teaching hospitals and all hospital with residents have excellent liability insurance and have their premiums paid up-to-date. It is not an, if this happens, but when it happens, patients lives are at risk and medical careers may be ended before even blossoming. But the old guard medical establishment feels this is the only way to teach medical students how to think on their feet and maintain medical initiation rites they had to endure.

Coauthor Lucian Leape, MD, an adjunct professor of health policy at the Harvard School of Public Health in Boston, Massachusetts, in a press release accompanying the article said “the current system amounts to an abuse of patient trust.” Well said doctor! Therefore, any patient entering a teaching hospital must be aware that patient safety is not high on the priority list. The initiation rite of medical residents is top of the list and you as the patient will have your safety put at high risk by residents lacking in sleep and probably not at their best for functioning effectively.

I know that I will be hard pressed to remain in one of these situations once I have reestablished by cognitive abilities if I am taken there in an emergency situation. My wife has been told not to allow this.

What is not clear is how much rest time the medical residents get between 24 or 28 hours tours of duty. This has to be wearing on their psyche as well as a drain on their health.

08 July 2011

Why not? Because most surveys are composed to get the answers desired, to limit what can be selected, and in general not very insightful. In the last three years, I would look forward to possibly completing a survey, but the more I completed, the more disappointed I became.

One common type of question is the ranking of several possibilities which expresses few of the choices I would have liked to have seen. Many were written to cover only what the people originating the survey wanted to see answered, not what the real world would like to answer or for some even what it is like in the real world of diabetes.

Then there are the questions which allow for one answer only and would have been better answered using a ranking. Who thinks these up? Is the person responsible even knowledgeable about diabetes? I really have to wonder!

Instead of selecting an answer from their list – why don't they allow for other answers that are probably more important to the people they what to complete the survey. Do I think some of the questions are idiotic? Very definitely. Until I can see all the questions being asked and decide if I even want to answer the questions, I will not take any more surveys. I am tired of selecting the answer or ranking and clicking enter or continue to see the next question.

Then there are the surveys to help the authors decide if you are a candidate for the questions they want to really ask and if you would be someone they want to take their survey or to participate in an online discussion. Those really irritate me and let me know that I will not be a part of something so narrowly focused as I am probably in total disagreement to begin with.

Now for the ones that make my blood pressure head for the stratosphere – in the next 17 months we will be bombarded with political surveys. Now maybe you will understand why I ditched the land line and went to a mobile phone with caller ID. Sorry folks, I will cast my vote the way I chose for the candidate I chose based on his/her stand on the issues – not that this can always be depended on as they soon learn to compromise. If they are compromising my health and issues I believe in, they won't receive my vote the next election.

If I have rubbed some people the wrong way, so be it. I have had it with the meaningless surveys!

06 July 2011

I am in somewhat of a shock this afternoon. Another friend has passed. From diabetes I think, but I am not positive as the family will not discuss the reason. I know that he has been in and out of depression the last few months.

All I have been able to find out is that he was in a coma and the doctors doubted he would ever recover out of it and the family decided to have life support stopped. I know from past conversations with him that this was his wish.

Am I affected by this – yes. This makes four friends in the last 20 months that have passed from diabetes related causes. Three from stopping dialysis and now this friend. All four had Type 1 diabetes. I cannot speak to the level of management for any of them as it was something that was seldom talked about. I can only imagine from the ages that the level of management was not what it should have been.

None of the friends or acquaintances that have Type 2 diabetes are in declining health and all have great attitudes about life. Of the six of us, five of us are on insulin and the sixth has said she is considering insulin since the rest of us are doing so well. I know from recent discussions that the A1c's range from a low of 5.4 to 6.4 and the age range is 44 to 74. It is somewhat surprising that the A1c's are almost the reverse order of our ages.

Of the remaining three Type 1 friends, I do not know what there A1c's are or have been. It is also surprising that for as much as we don't talk about our diabetes, that we keep finding others that also have diabetes. Two more with Type 1 today and one more with Type 2.

05 July 2011

Many are not even aware of World Diabetes Day around the world. Since the International Diabetes Federation (IDF) was good enough to address those in attendance at the 2011 Roche Social Media Summit and took some flack for this, I have some suggestions for the diabetes online community (DOC) for the 2011 World Diabetes day activities.

This is only a suggestion, but may give us more ideas that might help the IDF get more recognition in the USA and possibly accomplish some goals for the IDF. First, I suggest that those not receiving the IDF email newsletters go to the IDF website and subscribe. You may do so in the lower right corner of the home page. Yes, just like the American Diabetes Association (ADA) and the JDRF, they have a place for you to contribute and I am not asking you to do that, only if that is your desire.

Second, I suggest that everyone pick at least three or more newspapers in their area and write letters to the editors making them aware of World Diabetes Day and putting in a plug for the IDF. You may wish to have a listing for your blog site as well.

Third, we need to consider a campaign to encourage corporations and businesses to not spend the money for lighting up their buildings, but instead use the money saved over and above security lighting, to donate this to the IDF.

Fourth, a letter writing campaign to the pharmaceutical companies to contribute matching monies or value in products to the IDF.

Can this be accomplished – I believe so, but it is going to take everyone to actively participate and to spread the word to the international diabetes online community and enlist their help.

Let's forget the feel-good activities that did nothing to help those in need on previous World Diabetes days, and work for something that could benefit people this year. For those that wish only to participate in ADA and JDRF activities, you still should be able to do something, but let's make this a World Diabetes Day to remember.

My email address (or contact) is available on my profile page. These are just a few of the ideas and I am sure that can be others, so don't hesitate to bring them forward.

01 July 2011

I wish I had been able to attend, but some things just weren't meant to happen. Did I lose out? Maybe. I was fortunate to have a visit from an army friend of many years ago. We had reconnected about 12 months ago now and we spent two afternoons enjoying each others company. He is nearing retirement now as an endocrinologist and has been following my blogs the entire time.

We talked about our past and then about diabetes – I think we spent too much time on diabetes and blogging, but he was most interested in my research since I am not medically trained. We have a lot in common on many of the topics I write about and I think he was very kind about my understanding of some medical topics. I do draw on his knowledge about some topics and he has asked me to research some topics for him.

He supplies me with a few topics (URLs) and answers questions I may have. It was my blog on non-diabetic hypoglycemia that reconnected us after about 35 years. I am just happy that he found my research useful and the blog got us back together.

Now to the reports to-date from the Roche summit. I enjoyed David Mendosa's and Gretchen Becker's reports on Dr. Polonsky's speech to the group. This is one where I would have liked to have been in attendance. I have followed the Behavioral Diabetes Institute newletters for well over a year now and wish they had branches in one or two Midwestern cities as this could be very helpful for many with diabetes and depression.

I just hope that the International Diabetes Federation (IDF) will not look too unfavorably on the actions of a few who felt it necessary to “ambush” their representative, Isabella Platon. The IDF is doing a lot of good, and after all folks, this organization speaks for the majority of the world's population with diabetes. Yes, the IDF needs to be more active in the USA as it just might be able to do more for the PWD than the ADA which is governed by its advertising and doctor members and does not have the best interest in the patients.

At least there were some in the DOC that spoke with interest about the mission of the IDF and what they are working so hard to accomplish in the underdeveloped countries of the our world. At least they could remember the names, including the IDF President, Jean Claude Mbanya which one blogger chose to dismiss in an offhand manner.

I can see the support for JDRF as that is the organization dear to the majority of those in attendance, so it is right to be supportive of that organization. I would not expect anything less.

30 June 2011

This article started it all as people were asking Jenny Ruhl about it. Her response is here.

Then to make matters worse, many people were posting about this on many diabetes forums and some were actually thinking this might be an answer. It now appears some clearer heads have prevailed on several diabetes forums.

This also fits Gretchen Becker's blog about press spin as this is a ploy to find funding for what I agree is a very dangerous attempt to give people hope.

Here are two more articles - one from BBC Health. Another one is by WebMD from the presentation at ADA so we know this is not peer reviewed and is just a hope of a very few people. Even CBS News dot com had to use the information.

I agree with Jenny that this is not good science and badly flawed. On Monday, I expect to see more articles on this. Only one more article and not all that jazzed up about this.

As of this time, people may have become smarter and realized how poor this is and not published anything after WebMD gave it a big splash. Refer to my blog here as to some of the reasons behind our determining this is such poor research in addition to what Jenny writes.

17 June 2011

On Monday, June 13, the US Food and Drug Administration (FDA) issued a warning to all healthcare professionals to closely monitor all diabetes patients receiving laraglutide (Victoza) injections for thyroid C-cell tumors and acute pancreatitis.

This also is supported by Novo Nordisk in their letter stating that a recent assessment has showed that some primary care providers are not fully aware of the serious risks involved with the use of Victoza.

Even though the the evidence is from animal studies that prompted this alert, it is considered serious enough to warrant extra attention by healthcare professionals. The FDA recommends that patients with thyroid nodules noted by physical examination or imaging for other reasons be referred to an endocrinologist for additional evaluation.

The FDA urges physicians to observe patients carefully after initiation of Victoza therapy or dose increases for signs of pancreatitis. This includes ongoing severe abdominal pain that can sometimes radiate to the back, and which may or may not be accompanied by vomiting.

Read this important warning about Victoza (laraglutide) here. And if you have read my blog about Victoza here, also heed the warning.

22 April 2011

I have been in a fog lately. Too many tasks to do, things to accomplish, and nothing as far as studies that I have had real interest in. Most were poor to very bad studies and some were almost laughable when they try to factualize information that is not there.

So for the time being, until I either find something that is very interesting I will be away from this blog and putting what I have that still requires more research on my blog here.

Hope everyone has a happy Easter and I will be back, but only ocassionally for present.

07 April 2011

I do have to wonder when the different medical groups are going to become unified in their recommendations for daily dietary fiber intake. I see different ranges quite often. One groups orders 31 grams of fiber for everyone, another claims that women only need 25 grams, and men need 38 grams of daily dietary fiber. Most seem to recommend within this range, but I have seen more precise suggestions based on age, weight, and other factors.

Do we need standardization? It would seem wise as too many medical groups recommend on one number fits all. They do not specify what age range they are talking about or even if there are other factors involved in the determination. I am not sure whose recommendation to use and therefore I go with one I trust more that most which is the Mayo Clinic (see page 2). While their recommendation is from the National Academy of Sciences' Institute of Medicine (IOM), which I hesitate to use, it is reasonable.

This recommendation does not account for children for which I fault the IOM and Mayo Clinic. It does say that age 50 and younger for women the amount of daily dietary fiber should be 25 grams and for women age 51 and older the need drops to 21 grams. For men age 50 and younger the amount of daily dietary fiber should be 38 grams and for men age 51 and older the need decreases to 30 grams.

The best table for dietary fiber is this table by the World Health Organization and you can find it here. You may wish to bookmark it for future reference. It does account for children and the table is about one third down the page. There is other valuable dietary fiber information on the site as well.

Dietary fiber is sometimes referred to as bulk or roughage. Dietary fiber is found in plants, fruits, vegetables, and grains. Dietary fiber is part of a heart-healthy diet. It adds bulk and the full feeling quicker which helps control weight, aids digestion and makes bowel movements easier.

Dietary fiber is of two types – soluble and insoluble Insoluble fiber facilitates easier movement through you digestive system and increases stool bulk. Soluble fiber dissolves in water and forms a gel-like material. This helps lower blood cholesterol and glucose levels. The amount of each type of fiber varies by plant foods. This is why everyone recommends eating a wide variety of high fiber foods.

Benefits of a proper level of fiber in your diet are many and this is the reason for making this known over and over to people. Of course, the correct amount of fiber in your diet makes bowel movement easier and can help with preventing loose stools and for some people it may provide assistance from irritable bowel syndrome. Other benefits of a proper fiber diet is that it may lower your risk of developing hemorrhoids, and possibly other colon diseases.

06 April 2011

There has been some diabetes news, but most have been shockers trying to get peoples attention to lure more grant monies for research. To me this is not news, but gamesmanship to attract grant funds.

I have seen so many of these lately, that I am jaded in my views and need to get away from some of them. I am not sure that some of them are even legitimate studies or even designed to obtain results other than what the companies want to be shown.

A lot of this started for me when I wrote and posted this blog. To have a government agency develop a 10-year plan and not even encourage finding a cure, but to concentrate on managing diabetes and preventing complications, leaves me wondering whom has paid off whom at the government level.

Yes, this is an undocumented accusation, but it bothers me that our government does not care about finding a cure. Letters to my congressional representatives have not yielded even an acknowledgment of receiving them. I was asking questions that normally should yield answers.

So for the time being, if I am not here with a blog, I may not have found something that deserves attention or I have more research to complete before posting.

04 April 2011

Can you get past the fear of the dental office to accept dentists doing some primary care? I am not sure I could even though I have no fears of the dental office. I think I would be forced to look elsewhere for my dental work if primary care came to the dental office where I get my dental work done.

I know that the primary care physicians may be in short supply in the near future, but I am having serious problems with the ones trying to fill this vacuum. First the pharmacies, see my blog here, and now the dentists. I guess my initial reaction is one of lets not change the current system.

With what is happening, this may be wishful thinking, but I will do my best to avoid these situations. The doctor interviewed for this article, is very convincing and well-intentioned. He raises some excellent points and knows this will not happen overnight. He is determined that this should be the course of action for dental students of the future. Figuring that this will take three to five years for this to start, another five years for the first ones to graduate, we are eight to ten years before this begins to happen.

Then for other dental schools to actively turn out graduates, would require at least that long and you know that many students will not chose this area so even with all dental schools putting graduates in to the profession some areas will start to have this in ten to 15 years and probably a full 20 to 25 years before this becomes a complete reality.

The one area that could definitely be an advantage for the dental profession is aiding in the detection of diabetes. The doctor did not say diagnosis, but did emphasize screening and referring the patient to their doctor or referring them a doctor knowledgeable about diabetes. Since many primary care doctors have abdicated their responsibility in the area of screening and diagnosis, this is one positive I could see since often there can be signs that the dentist might see earlier like periodontal disease which has a link to diabetes.

So it will be up to the patient whether they will to accept some primary care from the dental profession. How fast this could become a reality remains to be seen, but if limited in nature, there may be a place for some types of primary care.

31 March 2011

This is an insight into what I have been working on the last few days and will take more time to fully digest – I don't like the pieces here and other pieces over there. I knew this was happening, but had not continued to follow it after the comment period was over. There is quite a few changes in the Americans with Disabilities Act that will affect many of us. From people with diabetes to service dogs, there is a lot digest and determine how regulations have changed and affect us.

The American Diabetes Association made this release which kicked my backside into action. The ADA is applauding the changes which provides clear and clear regulations protecting the rights of people with diabetes in the workplace. How far this will go in creating better climates and working conditions for people with diabetes is not as clear as I had hoped.

Some of it is bound to be tested in the courts and possibly to the Supreme Court. But I will leave this to those in the legal profession. Some changes are definitely for the best and hopefully some of these will undergo further definition in the future as there are some gaping holes still existing that need addressing. But I am straying away to areas not covered in the ADA press release.

The ADA boasts about their participation which is all well and good and I am satisfied that they did what they were able considering all the groups participating and demanding this and that regulation. Yet, I do wonder if they left some areas that were in need of action to get other regulations. This is the problem within our political system of compromise which leaves needs on the table.

Employment discrimination is a big issue addressed and for that I am thankful. The new regulations will benefit people with diabetes and employers. It will simplify the determination as to whether an individual is covered under the law and allow attention to be put on the issue of whether a person with diabetes is discriminated against because of diabetes.

I have much more information to work through and it is a time consuming task. I just wanted you to know some of what is occupying my time and why I needed a break from blogging. And I am enjoying some time away from research.

25 March 2011

This is not about diabetes; however, many people with diabetes can develop the painful rash known as shingles. Vaccination for herpes zoster (shingles) in older adults has been shown to reduce the risk of this condition. This also happens irrespective of age, race, or the presence of chronic diseases. This is the findings of a study published in the January 12 issue of JAMA.

Since the above came out, the Food and Drug Administration has lowered the age from 60 and up (in May 2006) to 50 and up. More studies are still required for further action, but at least people will be able to get once they attain the age of 50.

This vaccine has the potential to prevent tens of thousands of individuals from developing herpes zoster. There has been a lot of resistance to its use by clinicians and patients. I agree that solutions need to be found to allow people seeking to receive this vaccine and help them reduce to risk of having this painful experience.

The pain of herpes zoster can be physically disabling and it can also last for months and even years. To date approximately one million episodes occur in the USA each year. Apparently the risk does not vary by age at vaccination, sex, race, or with the presence of chronic diseases. It was determined that the vaccine created a 55 percent reduction in herpes zoster.

Chances are that if you can get the vaccination, you may have the ability to be involved in a study to assist in further analysis of the effectiveness of the vaccine. The most common side effects appear to be redness, pain, and swelling at the injection site and a headache.

Read about the article here and the FDA approval on March 24, 2011 here. And if you have more questions, WebMD has some answers here and here. Be sure to read the last reference if you have had chicken pox and look around the page and check out other information from the first WebMD link.

24 March 2011

Milk thistle is one of those natural remedies that works and for a variety of things. For those of us with diabetes that have trouble with non-alcoholic fatty liver disease (NAFLD) also named nonalcoholic steatohepatitis (NASH) this can be a real help. An active compound found naturally in milk thistle, silymarin, is shown to provide a significant degree of protection against NAFLD and abnormal brain aging.

Silymarin has shown that it can prevent and reverse liver damage. NAFLD is a chronic disease that is characterized by inflammation of the organ that releases a flurry of free radicals and liver enzymes. Left unchecked, NAFLD can progress to cirrhosis, carcinoma and death. NAFLD may affect up to 40 percent of adults in the westernized world.

The result of research published in the journal Hepatitis Monthly demonstrates the effectiveness of treatment with silymarin for the treatment of NAFLD. Researchers noted a significant decline in liver enzyme markers that indicate reversal of the disease, and no serious side effects were reported as a result of the natural treatment.

Silymarin has been found to protect the nerves and slow the brain aging process. Being one of the few compounds that is able to cross the blood-brain barrier, it has the ability to affect the neural function and chemical neurotransmitters.

Information from the journal Neurochemistry International shows that the nutrient is able to protect delicate glial cells in the brain against free radical damage that occurs from a low grade bacterial infection common in overweight and obese people.

Silymarin has demonstrated that it inhibits plaque formation and works to prevent Alzheimer’s disease. It works to clear protein amyloid plaques that form and prevent electrical and chemical signaling between neurons. Silymarin helps the brain to naturally clear amyloid plaque before it becomes tangled and restricts normal cellular communication.

Read about it here in John Phillip's blog. Also read what David Mendosa has to say about it and diabetes here. Until I read and then reread these two blogs, I realized how I had glossed over this when I wrote about it earlier, so I will spare you that.

23 March 2011

I am beginning to see more written about this. I am not yet sure how I feel about it, but the discussion has started so we need to read more to understand it. The buzz lately is using glycemic load instead of counting carbohydrates for determining the amount of insulin to inject before meals.

A new study at the University of Sydney in Australia hints at the number of carbs alone may not be the best method for determining how much insulin to inject. They are considering the glycemic load of food may be a more accurate method that takes into account how quickly it makes the blood sugar in our system rise. Foods with soluble fiber, such as apples and rolled oats, typically have a low glycemic index, one of the contributors to glycemic load.

Most of the study revolved around Type 1 diabetes and no mention has been made of Type 2 diabetes. Type 2 is being looked at for dietary change and oral medications, but those of us Type 2's on insulin seemed to be cast aside for now.

In the study using the glycemic load was more effective that carb count in predicting the blood sugar and insulin rise after a meal. A diabetes expert at the University of Washington in Seattle, not involved in the study commented that it was not certain the finding would hold up in people who are not completely healthy.

The glycemic load is calculated by multiplying the number of carbohydrates in grams per serving by the food's glycemic index divided by 100. Before a lot of this can become practical, more foods will need to have the glycemic index determined. There is some lists now, but a long way from complete to say nothing about determining the index based on how the food is cooked.

I see more studies being required and a lot of work needing to be done before this can become a practical reality, but Type 1's and Type 2's on insulin should continue to follow this to see if it will become reality in the future. Also needing discussion will be the complexity of computations required to determine the required dosage of insulin needed by type of insulin.

I also expect that there may be other factors that could affect calculations. Will the glycemic index and glycemic load be required on food labels. Finally, will all the medical professionals learn about the new calculations? For some reason this last question really bothers me as many hospitals and some professionals just don't keep up to date and can't count carbs now.

22 March 2011

This doctor has the right attitude about electronic medical records (EMRs). For him they are an aid in his work allowing him to access important medical information quickly which allows him more time with his patients. He correctly calls many physicians Luddites. This means that many see the downsides of technological advances and to not appreciate the positive side of EMRs.

This doctor is R. Centor in his February 28, 2011 blog. He is an academic hospitalist that enjoys his work in two hospitals and says it does not affect his bedside manner. He states “my bedside manner does not differ, because being at the bedside is a separate job from recording our visits – or at least it should be.

How I wish we all had doctors like this. Doctors that used to have their heads in the paper records will still have their heads looking at the computer and much of the time not giving their attention to the patient whether in a hospital, office setting, or as an outpatient. Dr. Centor emphasizes the patient first, he states he likes patients, and interacting with them to educate them. He takes his occupation seriously and does not desire to do harm to any patient.

An article in the New England Journal of Medicine says that technology may be harming patients. The article states that with all the new technology, and the risk adverse attitude of most doctors, they overuse the technology by over testing and over treating many patients to protect the patients and themselves. This is part of the reasoning behind the skyrocketing cost of medical care.

Even Dr. Centor would agree that many doctors forget their hard-earned knowledge and training and desire to avoid legal entanglements by relying on technology to be on the “safe side” of many diagnoses.

The NEJM article says this makes the U.S. system of medical care almost bankrupt and perpetuates serious economic and racial disparities. This makes our healthcare system rank in the bottom tier among developed countries in children's health outcomes.

The NEJM article says that the U.S. must rediscover the value of clinical judgment and
put technology is perspective and not as the save all that many would like to believe. The article does not think that technology should be the cover-all-possibilities tool, but a tool to be an aid when knowledge leaves us shaking our head because common sense cannot determine what may be wrong.

21 March 2011

As much as people have had news thrown at them about this bit of promising research and that supposed break through, this is news of a different nature and is not good news for finding a cure.

As much as many of us believe that private industry (Big Pharma) will never have a cure, I can agree that they will bury anything that big for as long as they can get away with it. I suspect the reason many pharmaceutical companies are teaming up with universities and medical schools is to keep tabs and quietly buy up promising ideas and keep them out of existence. You can bet they want to keep the profits from their medications by doing this.

I can hopefully say that maybe government agencies will not fall victim to bribery, but in this case they may be the culprit. The ten-year plan announced by the National Institutes of Health (NIH) is not a great thing. It sounds like all they are interested in is identifying research opportunities with the greatest potential to benefit people living with or at risk for diabetes and its complications. In other words, they will be directing the investigative community to improve diabetes treatments and identify ways to keep more people healthy. This says that they have little interest in a cure.

The NIH lays out goals to accelerate discovery in the relationship between obesity and type 2, and how both conditions are affected by genetics and the environment; the autoimmune mechanisms at work in type 1 diabetes; the biology of beta cells, which release insulin in the pancreas; development of artificial pancreas technologies to improve management of blood sugar levels; prevention of complications of diabetes that affect the heart, eyes, kidneys, nervous system and other organs; reduction of the impact of diabetes on groups disproportionately affected by the disease, including the elderly and racial and ethnic minorities

Under the plan, NIH will continue to push clinical research in humans, which has in the past led to effective methods for managing diabetes and preventing complications. So under this plan we can expect to see some improvements in treatments, but do not expect a sniff of a cure.

19 March 2011

A new report by several U.S. Department of Health and Human Services agencies, says that many people 65 and older are not getting the preventive health services they are entitled to and should be getting. Also Lynda Anderson, director of the Healthy Aging Program at the U.S. Centers for Disease Control and Prevention, said in a CDC news release that millions of Americans are not getting proven clinical preventive services.

Chief among these services are vaccinations for influenza and pneumococcal disease, including bloodstream infections, meningitis, and pneumonia. Also they are not getting help with quitting smoking, or screening for breast cancer, colorectal cancer, diabetes, high cholesterol, and osteoporosis.

With each passing day, about 10,000 Americans turn 65. The authors report that their report shows that there is a need to promote preventive services for older people and especially among minorities. The report also states that these services are not being utilized by many.

The report also suggests that many older adults may not be aware of the preventive services recommended for their age group and probably do not even know that the services are covered by Medicare.

Although the report list some innovative ways of making people aware of these services I was taken by the one suggesting providing flu shots at polling or voting stations on election days. The report also list increasing awareness through the media and providing services in convenient community settings.

"If we can help patients age 65 and older get the recommended preventive screenings and regular immunizations, we could significantly reduce unnecessary illness," Dr. Edward Langston, an American Medical Association board member, said in the news release.

18 March 2011

I know how people like to get diverted in believing one thing when they need to maintain an open mind. This study should make you realize that believing only in one dimension can be misleading and when you have diabetes, this can be very misleading.

We have all read that having diabetes doubles the risk of having a heart attack or stroke. This in itself is a good thing because it makes many doctors and patients pay closer attention to blood pressure, cholesterol, and other signs of a cardiovascular system that may be in trouble.

The forgotten causes of death are often set aside and little attention paid to them. This study states that 40 percent of deaths in people with diabetes are due to non-cardiovascular causes. Did that get your attention? It should. What are these causes and why should we include them?

For people with diabetes, your risks of dying from kidney disease has tripled, and your risk of death from infection (excluding pneumonia) or liver cancer has more than doubled. Other risks that have increased slightly are other types of cancers. These include ovarian, pancreatic, colorectal, breast, bladder, and lung cancers.

If you are still not convinced, diabetes raises the risk of death from Alzheimer's disease, chronic obstructive pulmonary disease (COPD), falls, nervous system disorders, digestive disorders, suicide, and liver disease. The study shows that even after accounting for the effects of other influences on the risk of death like body mass index (BMI), age, sex, and smoking, the above risks still remain. And lest anybody forget you can also die from natural causes and that risk seems to remain without the other risks. It is just that this risk does not go away.

This should be a wake up call to doctors and patients to be alert for non-cardiovascular causes as well as cardiovascular risks. Everyone with diabetes should be screened for cancer regularly and regular checks made for the liver and kidney functions. Infections need attention promptly by a doctor by the patient reporting visible ones and the doctor continuing to monitor white cells counts and using other tests.

The patient needs to keep vaccinations current when applicable, especially for pneumonia, hepatitis, and others. Read my blog here for the checklist and then enjoy the article about non-cardiovascular death risks here.

If I have caused fear, that was not intended. What I am seeking is to wake you up to things you may have put out of your mind because your cholesterol, blood pressure, and other cardiovascular problems are in control. You need to work on the other areas while managing the in control areas.

17 March 2011

The American Heart Association (AHA) on March 14, 2001 published a statement declaring that the AHA only supports bariatric surgery for the severely obese patients who have exhausted all other options to lose weight to lessen their cardiovascular risk.

This I am happy to see as after yesterdays announcement by the International Association for the Study of Obesity in London, United Kingdom suggests bariatric surgery for the pediatric population. While the statement was issued with the appropriate cautions, I was beginning to wonder where the bariatric surgeons were going to stop in their quest for additional patients to increase their cash flow.

At least now there is a voice of reason for not having this extreme surgery. The obesity committee of the AHA Council on Nutrition, Physical Activity, and Metabolism summarizes the most current data on bariatric surgery. "Medical experience acquired up to now supports the efficiency and safety of surgery for weight loss in severely obese patients on the basis of metabolic profile, cardiac structure and function, and related disorders," including diabetes, dyslipidemia, liver disease, systematic hypertension, and sleep apnea. However, the surgery has historically carried an operative mortality risk between 0.1% and 2.0%, and complications include pulmonary embolus, anastomotic leaks, bleeding, anastomotic stricture, anastomotic ulcers, hernias, band slippage, and behavioral maladaptation.

A lot of medical terms are part of the statement, but looking them up was a good lesson in the types of problems encountered and left out of many discussions because people (bariatric surgeons and advocates) intentionally do not want to scare people away.

The definition for anastomotic is derived from anastomosis which means in anatomy, communication between blood vessels by means of collateral channels, especially when usual routes are obstructed. Another meaning is Surgery, Pathology, a joining of or opening between two organs or spaces that normally are not connected. Hope this helps in your understanding.

With this from the AHA, hopefully other medical organizations will add their voice to the discussion against bariatric surgery except for extreme cases. It is time that some science has been added to the discussion and that we can rely on something beside emotion and desire to add to retirement accounts. Hopefully the FDA is listening, but don't count on them soon.

16 March 2011

A study about the unreliable internet as a source for information about diabetes has surfaced. And a doctor has blogged about it. While he loves the study, he says that patients will continue to ignore him and believe what they read on the internet.

If, and I say if, he was taking a positive attitude about the internet and his recommendations, more of his patients would listen to him. Rather than denouncing the internet, he should take the time to find some of the excellent sites for his patients and recommend they read them. This may be difficult for him as he seems to fail in understanding the dynamics of his patients. It certainly is not the internet as he makes use of it with some success.

Where I do agree with this doctor is the unreliable sites selling “snake oils” and “cures” which we know have only short-term benefits if even then, There are many such sites and when they are called into question, they just change their name and internet service provider and are back in business. I wish there was a way to regulate them, but that is not likely to happen. So the best we can do is ignore them and let people know when they ask about this or that site, how wrong that site is.

I would also agree with the doctor that there are a lot of very misinformed sites and sites putting out very poor messages. These can do almost as much damage as the “snake oil” sites.

Then there are some sites that do not follow the American Diabetes Association's guide and are varying in the recommendations to work for HbA1c's below 7.0 or the American Association of Clinical Endocrinologists recommendation of 6.5 for A1c. Often these sites encourage people with diabetes to work toward a goal of 5.0 or lower. They also tend to encourage more frequent testing of blood glucose levels which the doctors discourage and the medical insurance industry will not reimburse for. I even take this tack and am doing this myself because it has helped in my control. I know why and the reasons behind what I am doing and not blindly following some ideas. I have adjusted for my age and how my body reacts. This is what people need to understand.

This encouragement of more testing is done for the purpose of aiding the patients to understand how foods and other conditions affect their own body to help them develop healthier eating habits based on their own body chemistry. This can be an excellent tool for people to overcome the initial fear of what they can eat and to settle into a variety of foods generally more healthy than they have been eating.

There are many excellent sites on the internet about diabetes, but everyone needs to be aware of the charlatans. Read about the study here to get more information.

About Me

I am enjoying life, despite diabetes type 2. I am retired and enjoying the time I have for writing and photography. I was diagnosed with type 2 on Oct 2003, on oral meds for 4 months and they were doing nothing to really improve my daily readings. By cutting my carbohydrates I received the most improvement, but still not enough. Then I requested insulin, even though I did not like the thought of needles. That brought about the biggest change and A1c's in the lower 6's and upper 5's. Now I am working at maintaining them under 6.0 and hopefully nearer 5.5.